Deans' stroke musings: Predictors of poor outcomes in patients with intracerebral hemorrhage

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, April 28, 2025

Predictors of poor outcomes in patients with intracerebral hemorrhage

This prediction doesn't get survivors recovered, does it? So useless research!

You're fired!

in patients with intracerebral hemorrhage

Liling Zeng¹

Qixin Zhang²

Zhangyong Xia³

Wanzhen Cui¹

Jianwen Guo¹^*

¹Department of Neurology and Statistics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
²Zilkha Neurogenetic Institute, Keck School of Medicine of USC, Los Angeles, CA, United States
³Department of Neurology, Liaocheng People's Hospital, Liaocheng, China

Objective: To identify the predictors of 3-month outcomes in Chinese patients with intracerebral hemorrhage (ICH) receiving conservative management.

Methods: From October 2013 to May 2016, a total of 5,589 individuals with ICH were screened as part of the CRRICH study (Clinical re-evaluation of removing blood stasis therapy in treating acute intracerebral hemorrhage). Of these, 319 patients were ultimately enrolled. This study constitutes a post analysis of the CRRICH study. Potential predictors of poor outcomes following spontaneous ICH, initially identified through univariate analysis, were further evaluated using an unconditional multiple logistic regression model. Poor outcomes were defined as a modified Rankin scale score > 2 at 90 days post-ICH.

Results: Of the 319 patients (mean age 62.46 ± 0.71 years; male/female ratio 1.8:1), 89 (27.9%) had poor 3-month outcomes. Multivariable analysis showed increased odds of poor outcomes with older age (odds ratio [OR] 1.05; 95% confidence interval [CI] 1.02–1.08; p < 0.001), right hemispheric hemorrhage (OR 2.41; 95% CI 1.26–4.60; p = 0.008), intraventricular hemorrhage (OR 3.70; 95% CI 1.80–7.61; p < 0.001), and a higher National Institutes of Health Stroke Scale score (NIHSS) (OR 1.21; 95% CI 1.14–1.29; p < 0.001). Conversely, higher body mass index (BMI) (OR 0.88; 95% CI 0.77–0.99; p = 0.015) and shorter symptom-to-admission time (OR 0.77; 95% CI 0.62–0.97; p = 0.025) were associated with reduced odds of poor outcomes.

Conclusion: In conservatively treated ICH patients, right hemispheric involvement, ventricular hemorrhage, older age, and higher NIHSS score increased poor outcome risks at 3 months, while higher BMI and early admission reduced risks, aiding clinical prognosis prediction.

Highlights

• A higher body mass index is associated with lower odds of poor outcomes in intracerebral hemorrhage patients.

• Overweight patients are more likely to have better outcomes after intracerebral hemorrhage.

• Right hemispheric cerebral hemorrhage is associated with a higher risk of poor outcomes.

• An early time from onset to admission is associated with lower odds of poor outcomes in intracerebral hemorrhage patients.

1 Introduction

China faces the world’s highest stroke burden, with cerebrovascular diseases causing 149.49 deaths per 100,000 people (1). Intracerebral hemorrhage (ICH) is the main factor, making stroke the third leading cause of death, after cancer and heart disease (1, 2), and accounting for about one-third of global stroke-related fatalities (3). The predictors of neurological prognosis after spontaneous ICH have been extensively studied, with several risk factors, such as older age, a higher National Institutes of Health Stroke Scale (NIHSS) score, intraventricular hematoma, and 24-h hematoma expansion, widely recognized as significant prognostic indicators (4–7). However, large-scale studies focusing on prognostic predictors for mild ICH patients in China who receive conservative treatment alone remain scarce. Furthermore, the accuracy of several novel prognostic predictors, including body mass index (BMI) and right hemispheric cerebral hemorrhage, remains controversial (8, 9). For instance, while one study (10) found that a higher BMI was associated with reduced short- and long-term mortality in patients with aneurysmal subarachnoid hemorrhage, its relationship with ICH prognosis has been less explored. Similarly, some studies suggested worse outcomes in right hemispheric stroke compared to left hemispheric lesions (11, 12), whereas others reported no difference or even opposite results (13, 14). Thus, whether right hemispheric cerebral hemorrhage independently predicts poor outcomes in ICH patients remains unresolved.